• The Korean Journal of Nuclear Medicine
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• v.20 no.1
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• pp.25-31
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• 1986

This study was performed to establish normal hepatoscintiangiographic(HSA) pattern of hepatic blood flow and to investigate dynamic differential HSA findings of primary and metastatic carcinomas and abscess of the liver. HSA was carried out after intravenous bolus injection of 10 mCi of Tc-99m-phytate by obtaining sequential anterior images of 1-second exposure for 16 seconds. Observations included (1) baseline study of normal hepatic blood flow pattern by correlating with contrast angiogram, (2) time sequence phasing of normal HSA, and (3) analysis of altered patterns in primary and metastatic carcinomas and abscesses of the liver. Materials consisted of 20 normal subjects, 28 primary hepatocellular carcinomas, 16 metastatic carcinomas and 7 liver abscesses. Results were: (1) Normal HSA demonstrated 3 distinct phases of arterialization(AP), of arterial hepatogram(AHP), and of portal venous hepatogram(PVHP). The means of each phase were 5.3, 6.3 and 8.3 seconds, respectively. Portal vein could be seen in all but one of 20 normal subjects. (2) Pattern changes in diseases groups were early start of AP in carcinomas and very early start of AP in abscesses. AP became prolonged in all disease group. (3) Distinction between AHP was sharp in metastasis and abscesses but un sharp in primary hepatoma. Cold area or areas became vascularized in primary hepatoma but not in abscess. Cold areas of metastasis were inhomogeneously vascularized in late AP and throughout AHP and became relatively vascular as PVHP began. The cold area of abscess showed rim enhancement during AH and APH. These differences in HSA pattern were very useful in differential diagnosis of the diseases studied.

• Journal of Yeungnam Medical Science
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• v.22 no.1
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• pp.43-51
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• 2005

Background: To examine the ultrasonographic and magnetic resonance (MRI) imaging findings of a cervical mass type cervical pregnancy. Materials and Methods: The ultrasonographic and MRI findings of 5 patients pathologically confirmed as having a cervical pregnancy were analyzed retrospectively. On ultrasonography, the size and echo pattern of the uterine cervix, the shape and echo pattern of the lesion, the degree and the pattern of blood flow on the color Doppler study and the spectral Doppler pattern were analyzed. The shape, signal intensity, and degree and pattern of enhancement of the lesion were evaluated on MRI. Results: The uterine cervix was enlarged and the size of the lesion was 6.1 to 7.1 (average, 6.5) cm. The endocervical canal was irregularly dilated and showed heterogeneous echogenicity in all 5 cases. Four of the 5 lesions were heterogeneously hyper- or mixed echoic and remaining one was relatively homogeneous echogenic. Doppler ultrasonography revealed an increased vascularity of the peritrophoblastic flow pattern. In all 4 cases where MRI performed, the lesion was irregular in shape and the margin was not sharply demarcated. The T2-weighed image showed that the lesions were mixed signal intensity. Three of the 4 lesions contained high signal intensity nodular portions and a low signal intensity rim was observed along the margin of the nodular portions. The T1-weighted image revealed multiple signal voids along the periphery of the lesions and high signal intensity portions as a result of hemorrhage were noted. The dynamic enhanced study showed that the high signal intensity portions on the T2-weighted image were strongly enhanced similar to the vessels on the early phase and the contrast enhancement gradually decreased with time. Conclusion: A cervical mass type cervical pregnancy can be correctly diagnosed using the patient's clinical symptom, the elevation in the serum ${\beta}$-HCG level, and characteristic ultrasonographic and MRI findings.

• Investigative Magnetic Resonance Imaging
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• v.14 no.1
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• pp.21-30
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• 2010

Purpose : To examine the imaging findings of mucinous breast carcinoma and to evaluate the difference in these findings based on the histopathologic grade. Materials and Methods : We retrospectively analyzed the imaging features according to BI-RADS in 29 patients with surgically proven mucinous carcinoma. The histopathologic grade was classified as well-differentiated, moderately-differentiated and poorly-differentiated. Based on these criteria, the differences in imaging findings were statistically analyzed. Results : Mammography was available in 20 cases, which contained 17 mass lesions (85%) and 3 cases of normal findings. On ultrasonography (27 cases), mucinous carcinoma was observed as a mass with an oval shape (59.3%), a microlobulated margin (55.6%) or an inhomogeneous isoechogenicity (74.1%). On MRI (21 cases), mucinous carcinoma was commonly observed to have a lobular shape (76%), smooth margin (86%) or heterogeneous contrast-enhancement (61.9%). On the kinetic curve, there was a delayed wash-out pattern (52.3%). There were no significant differences in the imaging findings for each histopathologic grade except that a welldifferentiated tumor had an abrupt interface. Conclusion : A well-differentiated mucinous carcinoma tended to have an abrupt interface on ultrasonography, as compared with the moderately-differentiated one. Mucinous carcinoma showed a heterogeneous enhancement and a delayed washout kinetic curve pattern on dynamic MRI.

• Journal of the Korean Society of Radiology
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• v.82 no.5
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• pp.1218-1230
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• 2021

Purpose To compare the per-patient diagnostic performance of simulated abbreviated MRI (AMRI) to that of conventional MRI (CMRI) with full-sequence dynamic gadoxetic acid (GA) enhancement for early-stage hepatocellular carcinoma (HCC) screening in high-risk patients. Materials and Methods A total of 201 consecutive patients at high-risk for HCC, who underwent 3T liver MRI, were included in this retrospective study. The AMRI protocol comprised T2-weighted imaging, hepatobiliary phase imaging after GA injection, and diffusion-weighted imaging. For each patient, two AMRI and CMRI image sets were independently reviewed by two radiologists. Inter-reader agreement was assessed using Cohen's kappa value. A composite reference standard was used to determine the diagnostic performance of each image set for each reader. Results A total of 93 HCCs were detected in 79 patients. The inter-reader agreement was almost perfect for both image sets (κ = 0.839, 0.948). In AMRI, the per-patient sensitivity and negative predictive values (NPV) were 94.9% and 96.4%, respectively. In CMRI, the per-patient sensitivity and NPV were 96.2% and 97.5%, respectively. Conclusion AMRI, using only three sequences, had a comparable diagnostic performance to CMRI in screening early-stage HCC. AMRI could be an alternative HCC screening tool for high-risk HCC patients.

• Investigative Magnetic Resonance Imaging
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• v.2 no.1
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• pp.96-103
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• 1998

Purpose : To assess the clinical utility of turbo contrast-enhanced magnetic resonance angiography(CE MRA) in the evaluation of the aortic arch and its major branches and to compare the image quality of CE MRA among different coils used. Materials and Methods : Turbo three-phase dynamic CE MRA encompassing aortic arch and its major branches was prospectively performed after manual bolus IV injection of contrast material in 29 patients with suspected cerebrovascular diseases at 1.0T MR unit. the raw data were obtained with 3-D FISH sequence (TR 5.4ms, TE 2.3ms, flip angle 30, slab thickness 80nm, effective slice thickness 4.0mm, matrix size $100{\times}256$, FOV 280mm). Total data acquisition time was 4. to 60 seconds. We subjectively evaluated the imge quality with three-rating scheme : "good" for unequivocal normal finding, "fair" for relatively satisfactory quality to diagnose 'normal' despite intravascular low signal, and "poor" for equivocal diagnosis or non-visualization of the origin or segment of the vessels due to low signal or artifacts which needs catheter angiography. At the level of the carotid bifurcation, it was compared with conventional 2D-TOF MRA image. Overall image quality was also compared visually and quantitatively by measuring signal-to-noise ratios (SNRs) of the ascending aorta, the innominate artery and both common carotid arteries among the three different coils used(CP body array(n=12), CP neck array(n=9), and head-and-neck(n=8). Results : Demonstration of the aortic arch and its major branches was rated as "good" in 55% (16/29) and "fair" in 34%(10/29). At the level of the carotid bifurcation, image quality of turbo CE MRA was same as or better than conventional 2D-TOF MRA in 65% (17/26). Overall image quality and SNR were significantlygreater with CP body array coil than with CP neck array or head-and-neck coil. Conclusions : Turbo CE MRA can be used as a screening exam in the evaluation of the major branches of the aortic arch from their origin to the skull base. Overall imagequality appears to be better with CP body array coil than with CP neck array coil or head-and-neck coil.

• Investigative Magnetic Resonance Imaging
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• v.18 no.1
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• pp.43-51
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• 2014

Purpose : To review MR imaging finding of papillary lesion identified as additional suspicious lesion on MR image in women with biopsy-proven breast cancer and to evaluate upgrading rates after subsequent surgical histopathological diagnosis. Materials and Methods: Among 1729 preoperative MR image of women with biopsy proven breast cancer, US-guided CNB-proven 22 papillary lesions from 21 patients, which showed additional suspicious contrast enhancement other than index cancer on MR image, were subjected to the study. Some of these lesions underwent surgery, thus the comparisons between the histopathologic results were able to be compared to the results of US-guided CNB. Also retrospective analysis was done for MR findings of these lesions by BI-RADS MRI lexicon. Results: On MR imaging, 8 mass lesions, 7 non-mass lesions, 7 focus lesions were detected. All of the focus lesion (100%, 7/7) was diagnosed as benign lesion and showed plateau and washout pattern in dynamic MR image. After excisional biopsy, one of 9 benign papilloma (11.1%), 3 of 3 papillary neoplasm with atypia component (100%), 3 of 5 papillary neoplasm (60%) were upgraded to malignancy such as ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC). Conclusion: The MR images of papillary lesions diagnosed by US-guided CNB exhibit no significant differences between malignancy and benign lesion. Also 41.2% of the lesion (7/17) was upgraded after subsequent surgery. Thus all of the papillary lesions require excisional biopsy for definite diagnosis and the MR imaging, it's just not enough by itself.

• Korean Journal of Radiology
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• v.23 no.10
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• pp.976-985
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• 2022

Objective: To compare the clinical and radiological features of various etiologies of chronic diffuse lacrimal gland enlargement. Materials and Methods: We retrospectively reviewed 91 consecutive patients who underwent surgical biopsy for chronic diffuse lacrimal gland enlargement and were diagnosed with non-specific dacryoadenitis (DA) (n = 42), immunoglobulin G4-related dacryoadenitis (IgG4-RD) (n = 33), and lymphoma (n = 16). Data on patient demographics, clinical presentation, and CT imaging findings (n = 73) and MRI (n = 43) were collected. The following radiologic features of lacrimal gland enlargement were evaluated: size, unilaterality, wedge sign, angle with the orbital wall, heterogeneity, signal intensity, degree of enhancement, patterns of dynamic contrast-enhanced, and apparent diffusion coefficient value. Radiological features outside the lacrimal glands, such as extra-lacrimal orbital involvement and extra-orbital head and neck involvement, were also evaluated. The clinical and radiological findings were compared among the three diseases. Results: Compared to the DA and IgG4-RD groups, the lymphoma group was significantly older (mean 59.9 vs. 46.0 and 49.4 years, respectively; p = 0.001) and had a higher frequency of unilateral involvement (62.5% vs. 31.0% and 15.2%, respectively; p = 0.004). Compared to the IgG4-RD and lymphoma groups, the DA group had significantly smaller lacrimal glands (2.3 vs. 2.8 and 3.3 cm, respectively; p < 0.001) and a lower proportion of cases with a wedge sign (54.8% vs. 84.8% and 87.5%, respectively; p = 0.005). The IgG4-RD group showed more frequent involvement of the extra-orbital head and neck structures, including the infraorbital nerve (36.4%), paranasal sinus (72.7%), and salivary gland (58.6%) compared to the DA and lymphoma groups (4.8%-28.6%) (all p < 0.005). Conclusion: Patient age, unilaterality, lacrimal gland size, wedge sign, and extra-orbital head and neck involvement differed significantly different between lymphoma, DA, and IgG4-RD. Our results will be useful for the differential diagnosis and proper management of chronic lacrimal gland enlargement.

• Investigative Magnetic Resonance Imaging
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• v.13 no.2
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• pp.183-189
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• 2009

Purpose : To evaluate the usefulness of three-dimensional (3D) maximal intensity projection (MIP) reconstruction method in breast MRI. Materials and Methods : Total 54 breasts of consecutive 27 patients were examined by breast MRI. Breast MRI was performed using GE Signa Excite Twin speed (GE medical system, Wisconsin, USA) 1.5T. We obtained routine breast MR images including axial T2WI, T1WI, sagittal T1FS, dynamic contrast-enhanced T1FS, and subtraction images. 3D MIP reconstruction images were obtained as follows; subtraction images were obtained using TIPS and early stage of contrast-enhanced TIPS images. And then 3D MIP images were obtained using the subtraction images through advantage workstation (GE Medical system). We detected and analyzed the lesions in the 3D MIP and routine MRI images according to ACR $BIRADS^{(R)}$ MRI lexicon. And then we compared the findings of 3D MIP and those of routine breast MR images and evaluated whether 3D MIP had additional information comparing to routine MR images. Results : 3D MIP images detect the 43 of 56 masses found on routine MR images (76.8%). In non-mass like enhancement, 3D MIP detected 17 of 20 lesions (85 %). And there were one hundred sixty nine foci at 3D MIP images and one hundred nine foci at routine MR images. 3D MIP images detected 14 of 23 category 3 lesions (60.9%), 11 of 16 category 4 lesions (68.87%), 28 of 28 Category 5 lesions (100%). In analyzing the enhancing lesions at 3D MIP images, assessment categories of the lesions were correlated as the results at routine MR images (p-value < 0.0001). 3D MIP detected additional two daughter nodules that were descriped foci at routine MR images and additional one nodule that was not detected at routine MR images. Conclusion : 3D MIP image has some limitations but is useful as additional image of routine breast MR Images.

• Journal of the Korean Society of Radiology
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• v.83 no.1
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• pp.149-161
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• 2022

Purpose To investigate the correlation between computer-aided diagnosis (CAD) parameters in 3-tesla (T) MRI and pathologic immunohistochemical (IHC) markers in invasive carcinoma of no special type (NST). Materials and Methods A total of 94 female who were diagnosed with NST carcinoma and underwent 3T MRI using CAD, from January 2018 to April 2019, were included. The relationship between angiovolume, curve peak, and early and late profiles of dynamic enhancement from CAD with pathologic IHC markers and molecular subtypes were retrospectively investigated using Dwass, Steel, Critchlow-Fligner multiple comparison analysis, and univariate binary logistic regression analysis. Results In NST carcinoma, a higher angiovolume was observed in tumors of higher nuclear and histologic grades and in lymph node (LN) (+), estrogen receptor (ER) (-), progesterone receptor (PR) (-), human epidermal growth factor 2 (HER2) (+), and Ki-67 (+) tumors. A high rate of delayed washout and a low rate of delayed persistence were observed in Ki-67 (+) tumors. In the binary logistic regression analysis of NST carcinoma, a high angiovolume was significantly associated with a high nuclear and histologic grade, LN (+), ER (-), PR (-), HER2 (+) status, and non-luminal subtypes. A high rate of washout and a low rate of persistence were also significantly correlated with the Ki-67 (+) status. Conclusion Angiovolume and delayed washout/persistent rate from CAD parameters in contrast enhanced breast MRI correlated with predictive IHC markers. These results suggest that CAD parameters could be used as clinical prognostic, predictive factors.